In Treatment: Week 2

Photo of Paul

Gina is sitting at her computer when the phone rings. She answers and says “He is not here. He died a year ago. Please don’t call back.”

Paul returns to see Gina. He coughs and looks upset. He tells Gina that it’s true, that Kate has been seeing a man and then makes it that Kate told him all the details, omitting that he pushed for them. Paul feels like everything is falling apart — he tells her that Alex is leaving his wife, that Sophie is having an affair with her coach and alluded to something going on with his daughter. He says Kate says it’s his fault, that she is invisible to him as are the children. Gina says she is confused by all the names and suggests they focus on Kate.

“What am I supposed to do? What am I supposed to do now?”, Paul asks. He exaggerates what Kate told him and says he that he always thought sex was connected with intimacy for Kate. Gina asks if he asked for the details and when he admits he did, Gina says Kate wanted to make sure he got it. And confronts him that he knew. 

He takes a cold pill. She offers him tea, he asks for water.

He tells her about Jake and Amy. 

“Ultimatums from two women”, Gina observes, Kate and Laura. 

“Two”, he asks, “how about three?”, looking at Gina.

Gina asks if his relationship with Kate has been a wall that has protected him from attraction to his patients. Gina tells him she is not worried that Laura will breach the wall, but that Paul is hoping she will. Gina points out that Paul is surrounded by women who demand of him that he feel, that he face his feelings.

He tells Gina that Kate hates his work, hates the secrecy. She wants to make changes and he won’t let her, because he agrees with her, it’s not her space. He says he used to talk about patients in general terms with his family but not any more. 

He asks about the issue with Laura and the bathroom, would she let Laura use the bathroom in the house? That she wanted to breach the wall. Gina asks what he did. He said he panicked, he jumped up because he panicked, he thought she was doing it on purpose. Then he asks himself why he panicked and he doesn’t know. Gina asks if that has ever happened with another patient and Paul tells what happened with Sophie and the wet clothes — a lot more intimate than using the bathroom, Gina observes. Why the panic with Laura and not with Sophie? Why is it all right for Sophie and Kate to meet but Laura scared you?

Paul confesses that he sort of wished that Laura would go into the house and see Kate.  He tells Gina he clearly stated the boundary. Gina asks if he ever entertains the thought of having an affair with Laura. He knows how important it is to set the boundary, he knows it has to be clear that it will not happen. Gina asks further and Paul tells her what Laura said, how much she wants him. “That’s a lot to stave off’, Gina says. And then she suggests that Paul should transfer Laura to another therapist — because the situation with Kate has made him angry and injured. 

A female therapist? he asks? You?

Paul is angry with Gina, at her suggestion, at what he thinks she believes. He refuses to consider transferring Laura and tells Gina if it weren’t for Kate’s cheating, he wouldn’t have come back. And his suspicion that because his father cheated on his mother by having an affair with a patient, she thinks he will also. She can’t answer.

And then he brings up a patient he had referred to her, a male patient who fell in love with Gina. And that Gina fled to England in the face of it. He accuses her of abandoning her patient. 

Paul admits he was disillusioned with her. And he keeps hitting er with her failure with her patient.

Gina asks him to be honest — is he attracted to Laura? 

Gina asserts that she is suggesting they *talk* about transferring Laura and look at his reaction — he is attacking and defending.

The session ends with both of them exhausted.

In Treatment: Jake and Amy Week 2

Amy has arrived before Jake and is smoking when he arrives. Jake comes on to her as they are in the garden before going into Paul’s office. They joke about names for the baby and superficially things seem better.

Amy opens saying that she did not keep the appointment with her doctor because Paul was right, she needs to think it over. They are all smiles and happy, talking about getting along better. Amy says she thinks she may want this baby and has imagined the baby, which she thinks is a girl.

Paul asks if they have talked about this decision. Amy asks what he thinks. And he wonders , despite their apparent happiness, whether they shouldn’t talk about it. Jake says this is their last session because they have decided; Amy says not necessarily. Paul reiterates that they still need to talk about it.

While Amy speaks, Jake looks away. Amy gets up and goes into the bathroom. Next we see them leaving.

And Paul finds a spot of blood on the couch — so we may fairly conclude that Amy is miscarrying.

Paul calls for Kate to ask how to get the blood out of the couch. There is tension between Kate and Paul. He frets about whether or not there will be a stain because he says his patients will wonder. Kate says maybe now he will replace the couch — and then says that he could make the room nicer. She says that she is jealous of the room.

Paul tells her he went back to see Gina, which surprises Kate, who says she thought he despised Gina after what she wrote about him. Paul asks Kate why GIna is such a threat to her. Then they begin to fight about the kids, about Kate’s sense that she carries all of the parenting load. Paul resists the idea of sending their son to a school for gifted children, something Kate passionately believes would be best for him as he hates school and has no friends. Kate cries and tells him he does not make her feel she is the most important thing to him, not her, not the kids compared to what happens in his office. She is furious that he is energetic and engaged with his patients and old and tired with his family. Paul looks defeated and acknowledges that he may be out of touch with Max. Kate sits down on the opposite end of the couch, the distance reflecting how little actual contact there is between them. Kate keeps trying to pull the discussion back to their relationship, which Paul clearly does not want to talk about. “Why don’t we talk”, she asks? He checks the clock and says “we have a few minutes, let’s talk”.

Kate says, “I’m seeing someone”. Paul asks what she means and she asks what he thinks she means. He gets angry and asks about this man, who is he, where she sees him, what they do? She throws the details at him. Paul accuses her of deliberately betraying him while accusing him of being neglectful. One of those fights that takes couples over the brink into the territory of fatal wounds.  And then he sits again and says, “Congratulations. You have ruined any chance of saving this marriage.”

Kate tells him that it was past saving because he never noticed, because he never considered she might do something like this.

“Is it over? Are you going to keep on seeing him?”

Kate says it is up to him and he tells her to please leave.

There is a knock on the door. Paul tidies up and goes to answer, pulling himself together to meet with the next patient.

In this episode, we see one of the great, maybe the greatest occupational hazard for therapists. It is so very easy for therapists to get many if not most of their intimacy needs met in their work. The relationship is intimate, making us privy to  the deepest issues of our patients’ lives and though the work is demanding, we need only pay close attention in one hour increments with no requirement that we ourselves reveal our own interior. Patients are usually grateful and make us feel valuable. Compared with the mundane issues of family life — squabbling kids, household chores — life in the consulting room is vivid, alive, rewarding. And what goes on there cannot be brought back into the family, cannot be shared as other work usually can be. So the life of the therapist easily becomes split between the office and outside the office. 

But the intimacy of the consulting room, while real, is bounded and is not sufficient for either party. Therapists need friends and close family who will not make them special, will be honest with them, and both give and receive love. Our friends and loved ones help keep our feet on the ground because they know us and love us, warts and pimples and all. There is nothing like changing a dirty diaper or washing dishes or  the ordinary stuff of life to bring the therapist back from the cloud of adoration to solid ground again. But in order for those relationships to keep us grounded, they need our attention too, because when they become dysfunctional, the flight into the consulting room is an easy escape. If I am fighting with my husband or struggling with my kids or estranged from my friends, a call from a patient who needs me, who believes I can help and who adores me, rescues me from the unpleasant feelings those conflicts bring and makes me feel special and valued. So I become more open to my patients and avoidant of the people in my outside life. 

I suspect this is what has happened to Paul and now all of it is crashing in on him — his wife’s affair, his son’s school problems, his daughter’s possible problems and his patients are not providing the escape they once did because they keep bringing his own issues to the surface. The more Laura declares her love for him, the more Paul is faced with the rejection of him by Kate. Laura moves toward him as Kate moves away from him. Alex’s struggle for control over the sessions, over his life mirror Paul’s own efforts to keep everything together.  He can feel that someone in Sophie’s world has broken the rules just as he tries to push away his own fears that Kate has broken the rules of marriage. Life in the office no longer provides escape from the messes in his own life.

One other thing to file away — Kate mentions something about Gina having written about Paul in the past, in a way that suggests that this was a big factor in the rupture of Paul’s relationship with Gina. I suspect we will hear more about this as it sounds like Paul may have felt betrayed by something Gina published and that will take us into the issues clinicians face when writing about cases.

In Treatment: Paul

Photo of Paul

I wish it were more common that therapists chose to be in therapy themselves, but surprisingly it is less common than most people think. It is not a requirement of licensure or training, except for psychoanalytic training. So I am pleased to know that Paul has his own therapist, Gina, played by Diane Wiest.

The episode opens as he returns to therapy after an absence of some time. Right off the bat Paul sits in the therapist’s chair, which subtly suggests to us that it is not so easy for Paul to return. Gina has retired following the death of her husband. At Gina’s gentle prodding, Paul begins to talk about what has brought him back — he says he is struggling with his weight and is having another mid-life crisis, referring to one when he was 30 and another when he was 40. And finally he gets to the reason for calling Gina again — that he is losing his patience with his patients, feeling burdened by them, annoyed. He refers to Jake and says he really got under his skin — and if we listen between the lines, we can guess that there is something similar between his marriage and Jake & Amy’s. And Laura and the erotic transference. He ruefully says that if patients could see what therapists really think and feel, they would head for the hills. He tells her he is feeling anxious before sessions. 

And then we learn it has been ten years since he left therapy and Gina had assumed he was very angry.

Gina was Paul’s clinical supervisor and he left her, he says, because he felt she was interfering with his practice. And after a bit of banter, Paul confesses that he and his wife fight all the time and that it is interfering with his work. They fight over their son, his involvement with his practice, her emotional upset. Gina responds to him clinically, Paul tries to back out and turn back to his professional concerns, because he is reluctant to deal with his marriage. He makes a tentative commitment to try meeting with her a few times to see how it goes. And then begins to talk about his marriage again. And we learn that he seems to suspect she is involved elsewhere — an affair — and that their sex life has become lackluster. Gina offers her belief that if a therapist has difficulty with an erotic transference, it may well indicate problems in the therapist’s marriage, be a test of the marriage.

Gina confronts Paul on his evasion, that he tells her he is there to talk about Laura but keeps mentioning Kate, his wife. Paul is angry and defensive when he believes that Gina suspects him of acting out in the transference. He is prickly, argumentative, defensive. Paul critiques Gina and tells her how she is not doing well with him. Gina confronts him about his anger and resistance and tells him she does not know why he has come or what role he has placed her in. They allude to a complex and conflicted history, yet he says he could not think of someone else to talk with. Gina shows the impact of his verbal assaults and tells him he should get professional help with Laura.

The session ends in a draw and we are left uncertain whether Paul will return.

Working with another therapist in therapy is challenging. I have been in the position of being a therapists’ therapist and found it both difficult and rewarding. The kind of jockeying to be on top that we see Paul do with Gina is not uncommon. Resistance is part of any therapy and no less so when the patient is also a therapist. Paul shows us this very neatly when he gets prickly with Gina and won’t yield to her probes no matter how she frames them. In fact he accuses her of going too far and criticizes her approach. He is actually quite like Alex was with him in his efforts to control the session and keep her away from any points of vulnerability. Nevertheless, I suspect that her arrows about the situation with Laura and his need to deal with his marriage found their mark and because Paul is a good therapist and wants not to screw up, he will be back.